Provider Demographics
NPI:1053836700
Name:DEAGUIAR, SYLVIA LICHTENSTEIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:LICHTENSTEIN
Last Name:DEAGUIAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 GAYDEE CT
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4611
Mailing Address - Country:US
Mailing Address - Phone:707-291-8083
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT HILL AVE N STE 110
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3174
Practice Address - Country:US
Practice Address - Phone:707-823-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1017981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice